scholarly journals Acute Onset Peripartum Cardiomyopathy in a Woman with Severe Pre-eclamptia: A Diagnostic Dilemma

2013 ◽  
Vol 6 (1) ◽  
pp. 33-34 ◽  
Author(s):  
Sonela Basak ◽  
Pallab Rudra
Keyword(s):  
Late Pregnancy ◽  
Acute Onset ◽  
Peripartum Cardiomyopathy ◽  
Lifestyle Modifications ◽  
Diagnostic Dilemma ◽  
Life Threatening ◽  
Physiological Reserve ◽  
Proper Diagnosis ◽  
Future Pregnancy ◽  
Lateral Thinking

Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy that can present as acute life-threatening pulmonary oedema in late pregnancy or early puerperium, its diagnosis is mainly by exclusion of other causes. Morbidity is high due to the reduced physiological reserve in pregnancy. PPCM and severe pre-eclampsia can co-exist and their clinical presentation may overlap, making the diagnosis more difficult and often delayed, with potentially devastating consequences. Here, we would like to share our experience of such a case and present to the readers how we dealt with the challenge. As obstetricians we often do not resort to transthoracic echocardiography, which in our case prompted the diagnosis timely. Lateral thinking and a heightened suspicion does help. Proper diagnosis is extremely important not only for the immediate appropriate management but also for advising long-term lifestyle modifications to minimize risk and counselling for future pregnancy.

scholarly journals Unilateral mydriasis in a child with a ventriculoperitoneal shunt for obstructive hydrocephalus: a diagnostic dilemma

2020 ◽  
Vol 13 (12) ◽  
pp. e237257
Author(s):  
Monidipa Banerjee ◽  
Eiman Haj Ahmed ◽  
Kathryn Foster ◽  
Arundoss Gangadharan
Keyword(s):  
Ipratropium Bromide ◽  
Obstructive Hydrocephalus ◽  
Sudden Onset ◽  
Unique Case ◽  
Diagnostic Dilemma ◽  
Vp Shunt ◽  
Life Threatening ◽  
Unilateral Mydriasis ◽  
The Brain ◽  
Rule Out

There are several causes for sudden onset unilateral mydriasis, however impending transtentorial uncal herniation needs to be ruled out. This unique case highlights an uncommon adverse response to a common mode of treatment that leads to a diagnostic dilemma. A 3-year-old boy with a ventriculoperitoneal (VP) shunt for an obstructive hydrocephalus presented with an acute respiratory distress. He developed unilateral mydriasis with absent light reflex during treatment with nebulisers. An urgent CT scan of the brain did not show any new intracranial abnormality. A case of pharmacological anisocoria was diagnosed that resolved completely within 24 hours of discontinuation of ipratropium bromide. Although ipratropium-induced anisocoria has been reported in children, but to our knowledge none in a child with VP shunt for hydrocephalus. This emphasises the urgency in evaluating unilateral mydriasis to rule out life-threatening conditions. Clinicians should remember that ipratropium administered through ill-fitting face masks could cause this completely reversible adverse effect.

scholarly journals Successful treatment of pulmonary embolism in a patient with polycythemia vera by rheolytic thrombectomy

2019 ◽  
Vol 11 (4) ◽  
pp. 325-327
Author(s):  
Tufan Çinar ◽  
Mert İlker Hayıroğlu ◽  
Ahmet Oz
Keyword(s):  
Pulmonary Embolism ◽  
Polycythemia Vera ◽  
Myeloproliferative Disease ◽  
Antiplatelet Treatment ◽  
Clinical Onset ◽  
Cardiology Clinic ◽  
Life Threatening ◽  
Rheolytic Thrombectomy ◽  
Chronic Myeloproliferative Disease ◽  
Proper Diagnosis

Acute pulmonary embolism (APE) may lead to life-threatening conditions such as cardiac death and congestive heart failure. Thus, a proper diagnosis and management play a crucial role to prevent such complications. Moreover, APE is a rare clinical onset of chronic myeloproliferative disease. We herein describe a 67-year-old patient with polycythemia vera presented to our cardiology clinic with pulmonary embolism despite the fact that an intense antiplatelet treatment started secondary to acute myocardial infarction prior. Because the patient had hypotension and head trauma, rheolytic thrombectomy was performed successfully to restore adequate pulmonary perfusion.

scholarly journals Suspected botulism outbreak after the consumption of vegetarian pâté in the south of Viet Nam

2021 ◽  
Vol 5 ◽  
pp. 257
Author(s):  
Le Quoc Hung ◽  
Vo Ngoc Anh Tho ◽  
Do Thi Ngoc Khanh ◽  
Vo Thi Thanh Hien ◽  
Jeremy N. Day ◽  
...  
Keyword(s):  
Early Recognition ◽  
Specific Treatment ◽  
Case Series ◽  
Acute Onset ◽  
Viet Nam ◽  
Food Hygiene ◽  
High Clinical Suspicion ◽  
Cranial Nerve Palsies ◽  
Life Threatening ◽  
Botulinum Neurotoxins

Botulism and other botulinum neurotoxins-producing clostridia  are potentially life-threatening diseases caused by toxins produced by Clostridium botulinum. Here we reported a case series of six patients who presented with botulism following ingestion of commercially made pâté. The key features of presentation were acute onset of bilateral cranial nerve palsies and symmetrical descending weakness in the absence of fever resulting in the need for mechanical ventilation in all six patients. The clinical diagnosis of botulism was confirmed through the identification of C. botulinum from the suspected food source.  Given that botulinum antitoxin was not available in Vietnam at the time, and their severe status, all patients received a trial of plasma exchange therapy, but no clear benefit was seen. Due to its rarity, diagnosing botulism is a challenge, demanding high clinical suspicion. Successful outcomes depend upon early recognition and rapid initiation of specific treatment with botulinum antitoxin. There is a need to improve global access to antitoxin.  These cases, the first in Viet Nam, serve as a reminder of the need to maintain the highest possible food hygiene and preservation practices.

scholarly journals Resolution of Severe Neurologic Signs Following Intravenous Lipid Emulsion Therapy in a Young Dog With a Portosystemic Shunt: Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Amanda M. Spillane ◽  
Jenica L. Haraschak ◽  
Maureen A. McMichael
Keyword(s):  
Hepatic Encephalopathy ◽  
Lipid Emulsion ◽  
Reference Interval ◽  
Ammonia Concentration ◽  
Acute Onset ◽  
Portosystemic Shunt ◽  
Dramatic Improvement ◽  
Intravenous Lipid Emulsion ◽  
Life Threatening ◽  
Patient’S History

A 5-month-old male intact Great Pyrenees was presented for an acute onset of severe neurologic signs (stupor, absent menace, intermittent head turn to the left). The patient's history included possible naproxen ingestion with a maximum ingested dose of 59 mg/kg, exceeding the reported dose of >50 mg/kg known to cause neurologic signs. Blood sampling for baseline bloodwork was performed, and intravenous lipid emulsion (ILE) was subsequently administered, for treatment of the suspected toxicosis. Due to severe and life-threatening neurologic signs, other methods of decontamination were contraindicated and unlikely to be effective; extracorporeal therapy was also unavailable. Complete resolution of neurologic signs occurred 30 min after completion of ILE therapy. At this time, the owners found the missing naproxen tablets after returning home and the bloodwork results returned revealing findings consistent with hepatic encephalopathy. The fasted blood ammonia concentration immediately prior to ILE administration was 702.1 μg/dL (reference interval, RI: 24–36 μg/dL) and decreased to 194.1 μg/dL 24 h later. In the first 24 h, the patient also received three doses of lactulose, N-acetylcysteine, and intravenous fluids. The patient was subsequently diagnosed with a single, large intrahepatic portosystemic shunt via computed tomography and underwent an endovascular coil embolization procedure. Given the rapid and dramatic improvement in severe neurologic signs after ILE therapy alone, it is strongly suspected that this treatment resulted in improvement of hepatic encephalopathy.

scholarly journals Perforation Peritonitis at High Altitude

2018 ◽  
Vol 56 (210) ◽  
pp. 625-628 ◽  
Author(s):  
Bhawana Amatya ◽  
Paleswan Joshi Lakhey ◽  
Prativa Pandey
Keyword(s):  
High Altitude ◽  
Distal Gastrectomy ◽  
Acute Mountain Sickness ◽  
Emergency Laparotomy ◽  
Delay In Diagnosis ◽  
First Case ◽  
Life Threatening ◽  
Perforation Peritonitis ◽  
Proper Diagnosis ◽  
Mountain Sickness

Trekkers going to high altitude can suffer from several ailments both during and after their treks. Gastro-intestinal symptoms including nausea, vomiting, and abdominal pain are common in high altitude areas of Nepal due to acute mountain sickness or due to a gastro-intestinal illness. Occasionally, complications of common conditions manifest at high altitude and delay in diagnosis could be catastrophic for the patient presenting with these symptoms. We present two rare cases of duodenal and gastric perforations in trekkers who were evacuated from the Everest trekking region. Both of them had to undergo emergency laparotomy and repair of the perforation using modified Graham’s patch in the first case and distal gastrectomy that included the perforated site, followed by two-layer end-to-side gastrojejunostomy and two-layer side-to-side jejunostomy in the second case. Perforation peritonitis at high-altitude, though rare, can be life threatening. Timely evacuation from high altitude, proper diagnosis and prompt treatment are essential

Abstract 219: Cardiac Angiogenic Imbalance Leads to Peripartum Cardiomyopathy

2012 ◽  
Vol 111 (suppl_1) ◽  
Author(s):  
Zolt Arany ◽  
Ian Patten ◽  
Sarosh Rana ◽  
Sajid Shahul ◽  
Glenn Rowe ◽  
...  
Keyword(s):  
Cardiac Dysfunction ◽  
Systolic Dysfunction ◽  
Late Pregnancy ◽  
Peripartum Cardiomyopathy ◽  
Late Gestation ◽  
Multiple Gestation ◽  
Plasma Samples ◽  
Fatal Disease ◽  
Vegf Inhibitors ◽  
Circulating Levels

Peri-partum cardiomyopathy (PPCM) is a frequently fatal disease that affects women near delivery, and occurs more frequently in women with pre-eclampsia and/or multiple gestation. The etiology of PPCM, or why it associates with pre-eclampsia, remains unknown. We show here that PPCM is associated with a systemic angiogenic imbalance, accentuated by pre-eclampsia. Mice that lack cardiac PGC-1α, a powerful regulator of angiogenesis, develop profound PPCM. Importantly, the PPCM is entirely rescued by pro-angiogenic therapies. In humans, the placenta in late gestation secretes VEGF inhibitors like soluble Flt1 (sFlt1), and this is accentuated by multiple gestation and pre-eclampsia. This anti-angiogenic environment is accompanied by sub-clinical cardiac dysfunction, the extent of which correlates with circulating levels of sFlt1. Exogenous sFlt1 alone caused diastolic dysfunction in wildtype mice, and profound systolic dysfunction in mice lacking cardiac PGC-1α. Finally, plasma samples from women with PPCM contained abnormally high levels of sFlt1. These data strongly suggest that PPCM is in large part a vascular disease, caused by excess anti-angiogenic signaling in the peri-partum period. The data also explain how late pregnancy poses a threat to cardiac homeostasis, and why pre-eclampsia and multiple gestation are important risk factors for the development of PPCM.

scholarly journals Management of acute-onset and life-threatening respiratory distress of unusual aetiology

2010 ◽  
Vol 2010 (sep08 1) ◽  
pp. bcr0520103000-bcr0520103000
Author(s):  
R. M. Radke ◽  
T. Kessler ◽  
P. Lebiedz
Keyword(s):  
Respiratory Distress ◽  
Acute Onset ◽  
Life Threatening

scholarly journals Dyspnoea at Term in an Obese Mother

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
Vicky O'Dwyer ◽  
Yvonne O'Brien ◽  
Nadine Farah ◽  
Michael J. Turner
Keyword(s):  
Differential Diagnosis ◽  
Heart Disease ◽  
Obese Woman ◽  
Peripartum Cardiomyopathy ◽  
Morbidly Obese ◽  
Shortness Of Breath ◽  
Healthy Women ◽  
Obese Mother ◽  
Life Threatening ◽  
In Pregnancy

Peripartum cardiomyopathy is a serious, potentially life-threatening heart disease of uncertain aetiology in previously healthy women. We report a morbidly obese woman who presented with peripartum shortness of breath. We discuss the differential diagnosis of dyspnoea in pregnancy and highlight the complexity of care of the morbidly obese woman.

scholarly journals Anesthetic Management and Perioperative Events of Peripartum Cardiomyopathy during Cesarean Delivery a Series of Five Cases

2018 ◽  
Vol 03 (02/03) ◽  
pp. 198-203
Author(s):  
Sree Rama Mellacheruvu ◽  
Kousalya Chakravarthy ◽  
Khaliq Ahmed
Keyword(s):  
Cesarean Section ◽  
General Anesthesia ◽  
Case Reports ◽  
Anesthetic Management ◽  
Rare Condition ◽  
Late Pregnancy ◽  
Postoperative Management ◽  
Peripartum Cardiomyopathy ◽  
Morbidity And Mortality ◽  
High Morbidity

AbstractPeripartum cardiomyopathy (PPCM) is a rare idiopathic cardiomyopathy having an incidence of less than 0.1%. PPCM is associated with high morbidity and mortality rates ranging from 5 to 32%. In this review, the authors report a series of five PPCM cases. The case reports included pregnant women with PPCM, admitted in the hospital from October 1, 2017 to June 1, 2018 over a period of 9 months who required cesarean section. The authors aim to discuss the presentation, optimization, anesthetic management, and postoperative care of this rare condition. One of the cases was a booked case. The remaining four pregnant patients were referred in late pregnancy with features of congestive cardiac failure. One patient was in acute pulmonary edema, required intubation, and subsequently had cesarean section under general anesthesia. Four patients were managed with incremental epidural anesthesia. The need for proper preoperative optimization and intra- and postoperative management was discussed. The authors had one maternal mortality in our series. There was no neonatal mortality. Early diagnosis of PPCM, prompt treatment of heart failure, planning the delivery, and postpartum care can decrease maternal morbidity and mortality. Incremental epidural dosing can be used for cesarean section and has the advantage of stable hemodynamic status without the risks associated with general anesthesia.

scholarly journals RECURRENT AND LIFE-THREATENING PERIPARTUM CARDIOMYOPATHY: DIAGNOSIS, DELIVERY CONSIDERATIONS AND MANAGEMENT

2020 ◽  
Vol 75 (11) ◽  
pp. 2906
Author(s):  
Summer Aldrugh ◽  
Ely Gracia ◽  
Colleen Harrington ◽  
Theo Meyer ◽  
Lara Kovell
Keyword(s):  
Peripartum Cardiomyopathy ◽  
Life Threatening
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